To that end, it is important to monitor high-risk patients to facilitate early recognition of the cardiac arrest and initiate basic and advanced life support. To improve outcomes from pediatric cardiac arrest, it is imperative to shorten the no-flow phase of untreated cardiac arrest. Supporting this contention, late transfers to the ICU (e.g., unrecognized situational awareness failure events ) are associated with a higher risk of in-hospital mortality. , Although METs cannot identify all children at risk for cardiac arrest, it seems reasonable to assume that transferring critically ill children to an intensive care unit (ICU) early in their disease progression for better monitoring and more aggressive interventions would improve clinical outcome. Implementation of pediatric METs has been successful in that they have been temporally associated with decreased cardiac arrest frequency and mortality. While the composition and operating characteristics of these teams vary widely, their existence has become almost universal across pediatric institutions. Rapid response teams or medical emergency teams (METs) are in-hospital emergency teams designed specifically for this purpose. Because pediatric patients usually exhibit changes in their physiologic status in the hours leading up to their arrest event, interventions during the prearrest phase should focus on identifying children at risk for arrest, with special attention to early recognition and treatment of respiratory failure and shock. The prearrest phase refers to relevant preexisting conditions of the child (e.g., respiratory insufficiency/failure, sepsis, pulmonary hypertension, neurologic disability) and the events that precipitated cardiac arrest (e.g., respiratory decompensation, progressive hypotension and shock, pulmonary hypertensive crisis, drug overdose). Minimize interval to defibrillation, when indicatedĬonsider adjuncts to improve organ perfusion during CPRĬonsider E-CPR if standard CPR not promptly successfulĬontinue to address underlying arrest etiology to prevent recurrent arrestĮarly intervention with occupational and physical therapyĪCLS, Advanced cardiac life support BLS, basic life support CPR, cardiopulmonary resuscitation E-CPR, extracorporeal membrane oxygenation cardiopulmonary resuscitation.Īt least one-third the anteroposterior diameter of the chest (≈4 cm in infants and ≈5 cm in children)Ĭompressions provided for at least 80% of the arrest durationįULL chest recoil between all compressions Prioritize interventions to prevent progression to cardiac arrestĮarly recognition and activation of medical emergency response teams Optimize community education regarding child safety Interventions to improve the outcome of pediatric cardiac arrest should optimize therapies targeted to the time and phase of CPR, as suggested in Box 39.1 and Table 39.1. The four distinct phases of cardiac arrest and CPR interventions are (1) prearrest, (2) “no-flow” (untreated cardiac arrest), (3) “low-flow” (CPR), and (4) postarrest. Controversies related to pediatric cardiac arrest management are also discussed. This chapter focuses on pediatric cardiac arrest, CPR, and therapeutic interventions that impact clinical outcomes. With advances in resuscitation science, survival from pediatric cardiac arrest has improved substantially since the 1990s. In the past, survival outcomes were dismal, and many surviving children had severe neurologic sequelae. More than 20,000 children are treated with cardiopulmonary resuscitation (CPR) for a cardiac arrest in the United States annually. Pediatric cardiac arrest is not a rare event. Physiology-directed CPR, in which CPR is titrated to a patient’s physiologic response, is a promising technique to save more children’s lives from cardiac arrest. Real-time monitoring and feedback combined with reflective debriefings of team performance improves CPR quality and survival outcomes.Īttention to meticulous postresuscitation care-specifically, avoidance of hypotension and fever-improves survival outcomes. High-quality CPR (i.e., push hard, push fast, allow full chest recoil, minimize interruptions in chest compressions) improves cardiac arrest outcomes. The most common precipitating event for cardiac arrests in children is respiratory insufficiency restoration of adequate ventilation and oxygenation remain a high priority. There are four distinct phases of cardiac arrest and cardiopulmonary resuscitation (CPR): prearrest, no-flow (untreated cardiac arrest), low-flow (CPR), and postarrest.
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